- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.25 / $4,037.00 / $8,223.35
| Facility | | $185.25 | $4,037.00 | $8,223.35 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $67.98 / $122.37 / $172.67
| Facility | 52 | $67.98 | $122.37 | $172.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.00 / $3,438.00 / $3,438.00
| Facility | | $3,438.00 | $3,438.00 | $3,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,383.38 / $3,383.38 / $4,192.54
| Facility | | $3,383.38 | $3,383.38 | $4,192.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,705.00 / $5,265.00 / $10,536.00
| Facility | | $3,705.00 | $5,265.00 | $10,536.00 |